Cervicocranial arterial dissection: experience of 73 patients in a single center

Yung-Chien Huang MD , Ya-Fang Chen MD , Yao-Hung Wang MD , Yong-Kwang Tu MD, PhD , Jiann-Shing Jeng MD , Hon-Man Liu MD
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引用次数: 73

Abstract

Background

Arterial dissection involving cervicocranial arteries usually results in ischemia or SAH. This study correlated the clinical manifestations, image characteristics, and outcome of arterial dissection and compared the differences between arterial dissection of anterior and posterior circulation at our institute.

Methods

Clinical symptoms and neuroradiologic findings were retrospectively analyzed in 73 patients (6-75 years old) who had a spontaneous arterial dissection of cervicocranial vessels verified by angiography or MRI. Twenty-four cases of ACAD and 49 cases of PCAD were included in this study.

Results

The leading presentation of arterial dissection of ACAD group was ischemic stroke (79.2%), and that of posterior circulation was SAH (44.9%), followed by ischemic stroke (42.8%). In the ACAD group, the extracranial ICA was more commonly involved (62.5%), with long segmental narrowing the most common angiographic finding. In the PCAD group, the intracranial VA was more commonly involved (81.6%), with alternating narrowing and dilatation the leading angiographic picture.

All the cases presenting with ischemic stroke or headache were conservatively treated with anticoagulants or antiplatelets, except for one treated with intra-arterial thrombolysis for thromboembolism in basilar artery at an early stage. One of them died of progressed brainstem infarct in spite of anticoagulation therapy. All the others reached improved or stable clinical condition. Eighteen cases were treated by surgical or endovascular intervention. None of them had rebleeding. Of the 5 patients with SAH due to dissecting lumens without treatment, 2 died of rebleeding.

Conclusions

Ischemia is the predominant presentation of ACAD; and PCAD has similar occurrence of SAH and ischemia. Intracranial arterial dissection is not uncommon; and it should be kept in the list of differential diagnosis of young stroke. Aggressive treatment of arterial dissection presenting with SAH should be considered; otherwise, rebleeding may occur.

单中心73例颈颅动脉夹层的经验分析
背景:涉及颈颅动脉的动脉夹层通常导致缺血或SAH。本研究结合我院动脉夹层的临床表现、影像学特征及预后,比较我院前后循环动脉夹层的差异。方法回顾性分析73例(6 ~ 75岁)经血管造影或MRI证实为自发性颈颅血管夹层的患者的临床症状和神经影像学表现。本研究纳入24例ACAD和49例PCAD。结果ACAD组动脉夹层以缺血性脑卒中(79.2%)为主,后循环以SAH(44.9%)为主,其次为缺血性脑卒中(42.8%)。在ACAD组中,颅外ICA更常见(62.5%),长节段性狭窄是最常见的血管造影发现。在PCAD组中,颅内VA更常受累(81.6%),血管造影主要表现为狭窄和扩张交替。除1例早期基底动脉血栓栓塞患者行动脉内溶栓治疗外,所有缺血性卒中或头痛患者均应用抗凝或抗血小板药物保守治疗。其中一人在抗凝治疗后死于脑干梗塞进展。其余患者临床情况均好转或稳定。18例经手术或血管内介入治疗。他们都没有再出血。5例因管腔解剖而未经治疗的SAH患者中,2例死于再出血。结论ACAD的主要表现为化学反应;pad与SAH和缺血发生率相似。颅内动脉夹层并不少见;并应列入青少年中风的鉴别诊断清单。应考虑对伴有SAH的动脉夹层进行积极治疗;否则,可能发生再出血。
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来源期刊
Surgical Neurology
Surgical Neurology 医学-临床神经学
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